High Blood Pressure

There is no other medical condition that is so pervasive among seniors than hypertension (high blood pressure).

It is estimated that 40% of Canadians over the age of 55 have the condition and the numbers increase with age. Approximately 95% of Canadians will develop hypertension if they live an average life span. To a great extent its onset can be delayed or the need for medication postponed; it is easy to diagnose; and in most cases individual lifestyle changes along with medication can effectively reduce blood pressures to normal ranges.

Failure to effectively manage one's hypertension increases the risk of a number of serious complications. Here is what you should be aware of to effectively manage your blood pressure. Many Canadian websites are excellent resources for further information such as www.hypertension.ca and www.heartandstroke.ca/BP.

Blood pressure is a measure of the pressure your heart creates in pumping blood into your arteries. It is measured in how high it will raise a column of mercury. Systolic pressure, the top number, is the pressure when your heart contracts and diastolic pressure, the lower number, is the pressure measured when your heart relaxes between beats.

Normal blood pressure is below 140/90 but recordings nearing this level are considered high normal and should be monitored more frequently in addition to lifestyle changes to reduce risk. Home monitoring normal levels are 5 points lower at 135/85. For diabetics and those with chronic kidney disease normal levels are below 130/80.

In most cases there are no symptoms with hypertension which is why seniors, in particular, need to have their pressure taken at least yearly. If the pressure is above these levels, it is time to seek medical advice. Fortunately, there are now a number of opportunities for individuals to monitor their pressure, from drug store and home monitoring devices to clinics and community nursing facilities. The 2008 Canadian Hypertension Education Program (CHEP) encourages hypertensive patients to use an approved home device.

Results should be documented and provided to a physician if results are consistently at or above the normal levels.

Unless the levels are very high, the physician will monitor a few recordings and provide advice on lifestyle changes before initiating drug therapy.

The cause of hypertension in 95% of cases is due to essential hypertension. Although not fully understood, there is evidence that the walls of larger arteries become more rigid and/or smaller vessels become narrower. What is known is that there are a number of risk factors connected with hypertension. These include:

family history

obesity

sedentary life style

high sodium diet

excess alcohol consumption

diabetes

aging

diet low in potassium, magnesium and calcium

high cholesterol

stress

Understanding these factors provides very clear choices for those intent on delaying the onset of hypertension or helping to manage established high pressures with or without medication.

These are the things you should do:

Weight control is essential in managing this condition in addition to reducing the risk of coronary heart disease, diabetes, arthritis and joint problems, stroke, gallbladder disease, sleep apnea and some types of cancer

Besides dieting, reducing calories and the fat content of your meals, exercising is important in blood pressure control. The Heart and Stroke Foundation of Canada recommends that you make physical exercise a part of every day. Thirty minutes a day of brisk but comfortable walking or a similar regime can have a profound beneficial effect on blood pressure as well as reducing the risk of coronary heart disease and stroke, improving the level of good cholesterol, reducing weight and improving your overall health and well being. Snowbirds have the advantage of warmer climates in the winter to pursue this objective. Ask your physician what's appropriate for you.

Cutting back on salt. Not only should you not add salt at the table, but you should also avoid its use in cooking. Shop wisely, becoming aware of and avoiding many sauces, processed foods and soups most of which are high in salt. Although nuts are recommended, watch for the salt content. Other spices and a salt substitute which can be purchased at a pharmacy are acceptable replacements to flavor your food. Ask your pharmacist. Most restaurant food is high in salt content and should be reduced. No other change in your daily living pattern has such an important effect than reducing your salt intake.

Limit your alcohol intake to 2 drinks a day for men and 1 drink a day for women.

If you smoke, quit.

Follow the DASH DIET (Dietary Choices to Stop Hypertension). This diet is low in fat, including saturated fat and emphasizes more vegetables, fruits, whole grains and low fat dairy products.

Manage your life to avoid excessive stress as much as possible.

The reasons for all this attention to elevated blood pressure is because the failure to adequately control your pressure places you at significant risk for a number of serious or life-threatening conditions. These include:

stroke

heart attack

congestive heart failure

atrial fibrillation

kidney failure

peripheral vascular disease

dementia.

Statistics show there are not only many seniors who do not know they have hypertension but also there are many who are inadequately treated. If you have borderline or established high blood pressure do your best in adhering to aggressive lifestyle changes in addition to following your physician's drug regime. When first diagnosed, your physician will usually do a number of blood tests, a urinalysis and an electrocardiogram to rule out other risk factors and causes of your hypertension.

Most newly diagnosed persons will be started on one drug, often a diuretic (fluid pill). Most will need at least 2 medications to bring levels to normal. Be patient if you are not immediately responding and recognize that your physician may have to see you a number of times to adjust medication and dosage to your individual needs. Remember the normal levels and recognize that everyone should be registering normal blood pressures most of the time. If not, treatment is inadequate. Remember, between your actions and your physician's medication regime, you should have a normal pressure.

We now have a wonderful opportunity of monitoring our own blood pressure. Through the use of drug store machines and home monitoring devices not only are you able to take and record your own pressures in a more relaxed environment but you also are able to provide these results to your physician for her/him to more accurately assess whether the office recordings are higher (white coat syndrome) or in some case, lower than your home recordings. For snowbirds who are away from their family physician for many months, these documented recordings will alert the person if pressures rise unexpectedly, necessitating immediate attention as well as being beneficial to their own physician in the management of their drug therapy upon their return home. The home devices can be purchased from most pharmacies for $80-$120. The easiest to use is the automated wrist cuff. Look for a logo AAMI or BHS on the packaging indicating the instrument meets the international standards for accurate blood pressure measurement.

Read the instructions carefully. Such instruments are accurate if you follow the requirements for optimal testing, including relaxing for 5 minutes before recordings, comfortable seating with back support, no caffeine within the past hour, no talking during the recording and not crossing your legs. Persons with larger arm circumferences must use a larger cuff size for accurate recordings found only with the upper arm devices. Ask your pharmacist.

Many seniors take a laisee faire attitude towards blood pressures that are consistently elevated, whether on medication or not. Unfortunately, this inattention leaves them at high risk for development of one of the major complications of hypertension. Many assume that because they are on medication "there is no worry" and they need not follow the personal changes in their lives which are so much a part of proper management.

Proper treatment in persons over the age of 60 reduces:

the incidence of stroke by 40%

coronary artery disease (which leads to heart attack) by 15%

cardiovascular mortality by 33%

overall mortality by 20%

Know and understand these management tips. Your physician and today's excellent medications are important components of proper blood pressure management. But the personal choices you make in conquering this major medical condition are just as important in maintaining your pressure at normal levels. They may just save your life!

Did you know...

More than 40% of people in Canada who have high blood pressure do not know that they have it.

Of Canadians with high blood pressure, only 16% have it treated and under control.

It is estimated that up to three in 10 Canadians have hypertension because they consume too much salt.